The Science of Addiction, the Art of Recovery: A Care Model

In the first two installments in this series, I described addiction as the most complex disease of humankind and underscored that its treatment suffers from the lack of well-designed research and treatment protocols. As a result, addiction treatment is idiosyncratic—if you go to treatment center “A,” the treatment is focused on one approach, while treatment center “B” has a completely different way of addressing the illness. In this article, I will discuss what the core principles that form the foundation of our care model. In future articles, I will discuss how the RiverMend model stands on the foundation of these principles and uses them to build a sophisticated addiction care system.

Principle 1:
Addiction Is a Chronic Disease Despite recent advertisements to the contrary, addiction is a chronic illness; there is no addiction “cure.” An illness is defined to be chronic if it waxes and wanes over time, and recurs if it is not held in check with repeated surveillance and management. Cases of spontaneous remission do occur, but they are statistically the exception and not the rule. Some people have a period of heavy drinking and stop without treatment. This is not addiction, but a situational behavior that discontinues by itself. Addiction is diagnosed when using specific criteria that differentiate it from problem drinking. Even when chemical use progresses to the point of addiction, spontaneous remission is possible but rare. Some cancers, for example, on rare occasion go into remission, amazing the patient and doctors alike. Just as we would not stop treating cancer because of a rare remission, we should avoid the magical thinking that addiction goes away on its own.

We also know that addiction changes characteristics over time flagyl tablets 400 mg. The cocaine addict may stop using cocaine only to turn to alcohol or another drug, for example. Even “non-chemical addictions” metamorphosize over time; many young women who are bulimic go on to develop alcohol or another chemical addiction. Recovering addicts and alcoholics have to be wary of all addicting substance and behaviors such as gambling, pornography, and compulsive spending.

The medical community is slowly accepting a similar truth in other chronic diseases, such as diabetes. The diabetic patient must learn how to test their blood sugar, control their food intake and exercise and adjust their insulin dose carefully to stay alive and remain healthy over the long run. A required and central aspect of diabetic treatment is teaching the individual how to manage their chronic illness. Learning how to manage the brain effects of addiction for the addict is very similar. The recovering addict or alcoholic has to master and practice certain skills to ensure a good outcome. They have to exercise these skills through their lifetime to keep their chronic condition in remission. Failure to acquire and execute these skills, whether in it be in diabetes or addiction, leads to medical disaster.

The principle that addiction is a chronic disease teaches us that a central component of treatment is learning new skills—and practicing those skills until they become automatic—to prevent the chronic illness from rearing its ugly head down the road. This principle also asserts that executing recovery skills is a lifelong process, not something you do for several months and then declare lifelong victory.

Addiction is corrosive to qualities we associate with a full, meaningful, and respectable life. In order to continue addictive behaviors, addicts and alcoholics begin to lie, for example. The most respectable and upstanding citizen becomes conniving and manipulative in the service of their addiction, a harsh master. Others see the personality deterioration of their afflicted friend or family member and are at a loss to explain what is happening. As the illness progresses, the many facets of the addict’s disintegrating personality create chaos, frustration, and confusion for those around them.

Almost every medical condition is worsened by addiction as well. Chronic pain in the addict worsens, even, for example, in the face of escalating doses of opioid pain medications. Gastrointestinal illnesses, autoimmune diseases, and high blood pressure get worse. People with strong faith lose their way once addiction takes over.

Principle 2 teaches us that treatment must systematically rebuild lost emotional, physical and spiritual health. Stopping the addictive use of substances is just the first step in a long journey.

Principle 3: You Have to Stop Addiction Behaviors Before Meaningful Improvement Occurs
Once individuals have succumbed to addiction, they unable to improve if they continue their specific addiction behaviors. Active addiction stops psychological progress. One-on-one outpatient therapy commonly fails to help a substance-addicted individual improve because it is difficult in such a setting to interrupt alcohol or drug use. This may seem obvious, but is nonetheless profound: “You can’t get better (in any meaningful way) if you do not stop drinking.” We cannot expect an addicted individual to learn healthy coping strategies if they continue to use alcohol, drugs or food to “fix” their problems. Education about what addiction is helpful. But it is foolhardy to attempt to teach how to avoid high risk exposure to substances when the brain attention and motivational circuits of the active of the addict’s brain are swamped by the very substances we are teaching them to avoid.

This lack of growth extends to an addict’s or alcoholic’s emotional problems as well. If a depressed alcoholic starts taking medication for depression, the depression improves little, if at all, until the alcohol use stops. Couples begin therapy to fix problems, but if one or both halves of the couple are actively addicted, substantial improvement remains elusive. Addiction decreases psychological insight, thwarts the efficacy of antidepressants and blocks behavioral change in all areas. Principle 3 teaches us that stopping the addictive substances or behavior must be the first order of business in addiction treatment. The addictive process must be contained before any meaningful change occurs.

Principle 4: Treatment Must Repair the Whole Person—Stopping the Addiction Is Just the First Step toward Change
To a large degree, Principle 4 is derived from the first three principles described above. Addiction is a chronic illness (Principle 1) that damages all aspects of humankind, physical health, emotional balance, interpersonal connection, and spiritual pursuit (Principle 2). We know that the individual afflicted with addiction has to stop addiction behaviors before any meaningful change occurs (Principle 3). Because of the pervasive effects of addition on an individual (and his or her family and community) true change involves both the interruption of the addiction behaviors (drinking, taking drugs, gambling, etc.) and the repair of the whole person. True repair, and thus complete treatment, should visualize the interruption of drinking or drug use as a necessary first step of the long journey of recovery.

RiverMend Health Centers uses these four principles as the bedrock of its treatment system. Treatment time is measured in many months, rather than weeks. All aspects of patients are evaluated, from the physical to the spiritual. The first phase of treatment focuses on interrupting addiction behaviors, whether alcohol or drug use, gambling, addictive eating, gambling, and/or sexual compulsivity. RiverMend Health Centers looks at the person as a whole who has to take the first step of change towards health.